This paper reviews the incidence of and risk factors associated with congenital cardiac malformations. The management options available are then reviewed. These include a detailed accurate diagnosis of the lesion and a functional assessment of cardiac activity. The importance of detecting major chromosomal anomalies is stressed with abortion being offered to the parents of a fetus with chromosomal anomalies or a highly fatal defect. The lack of clear-cut data on which to base the indications for cesarean section in these patients is stressed.